Antisperm antibodies

Antisperm antibodies (ASA) are antibodies directed against antigens of the sperm membrane that may compromise its functional integrity. The content of antisperm antibodies in semen reflects the degree of impairment.

Generally, no relationship is found between ASA and decreased spermatozoa concentration or motility, but impaired sperm function due to the attachment of ASA to their membrane has been identified. Antibodies directed against spermatozoa membrane antigens have negative effects on spermatozoa fertility: by binding to the sperm surface, they can impair spermatozoa penetration through the cumulus and/or zona pellucida, acrosomal reaction, spermatozoon-egg cell interaction, and present spermatozoa for destruction by the immune system. This binding can cause spermatozoa agglutination. Sperm agglutination can also be caused by infectious diseases of the urogenital tract. Therefore, when spermatozoa agglutination is detected, it is necessary to rule out urogenital infections in semen culture. The presence of ASA should be excluded in the case of a repeated negative postcoital test, as ASA is associated with impaired spermatozoa penetration and progression in the cervical mucus. The presence of ASA should also be suspected in men with subfertility, a history of genitourinary trauma, decreased spermatozoa motility or spermatozoa agglutination according to the spermogram. ASA is detected in both men and women. ASA are detected in 8.1-30.3% of infertile men (2.4-10% in healthy men) and in high titre in only 6-7% of infertile men (not detected in healthy men). Most often (up to 70%), ASA are detected in obstructive urogenital diseases in men, in acute and asymptomatic urogenital infections, chlamydia, and in patients with testicular cancer. ASAs are also found in cryptorchidism and orchiopexy. It has been shown that ASA is not detected in boys for two years after cryptorchidism surgery, whereas in adult men who have undergone such surgery, ASA is detected quite often, up to 40% of cases. In addition, ASA is found in homosexual men, HIV-infected men, patients with varicocele and spinal cord disease. 

 Due to the risk of Intra Cytoplasmic Sperm Injection (ICSI), many fertility specialists determine anti-sperm antibodies before choosing an appropriate reproductive technology. In infertile men with intermediate or low ASA titres, treatment with corticosteroids and superovulation stimulation combined with intrauterine insemination was more effective. This treatment method was not as effective in men with high ASA titres, they were more likely to conceive using the intra cytoplasmic sperm injection (ICSI) technique.

 The detection of ASA is included in the list of standard tests for the diagnosis of male and female infertility. ASA can be detected in circulating blood, in seminal fluid or directly on the surface of spermatozoa.